NPIMap

Organization Active NPI

Georgia Highlands Medical Services Inc

  • Federally Qualified Health Center (FQHC)
  • Cumming, GA
National Provider Identifier
1194987412
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GEORGIA HIGHLANDS MEDICAL SERVICES INC
Practice address
540 Dahlonega St
Cumming, GA 30040-2110
Phone
(770) 887-1668
NPI assigned
Jun 27, 2008
Last updated
Oct 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Todd Shiflett
Title
Ceo
Phone
(770) 887-1668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

540 Dahlonega St
Cumming, GA 30040-2110

Mailing address

PO Box 307
Ga Highlands Medsvcs, Professional Park Family Pra
Cumming, GA 30028-0307
Phone (770) 887-1668

Other names 1

  • GHMS Cumming Elementary Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040302001307 GA Part B Supplier - Clinic/Group Practice 5890682017 Receives reassigned benefits from 26 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Canton, GA; Dawsonville, GA; Cumming, GA; Cartersville, GA; Buford, GA
O20230328001588 GA Part A Provider - Federally Qualified Health Center (FQHC) 5890682017 Practice locations: Cumming, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194987412. Details of each certification follow.

Federally qualified health center certification: CCN 111195

Legal name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 17, 2023
Last certification
Jan 17, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1979 in GA
Enrollment address
540 Dahlonega St
Cumming, GA 30040-2110

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

220 Oakside Ln
Canton, GA 30114
Phone (678) 807-1050

775 West Ave
Ste A
Cartersville, GA 30120
Phone (470) 315-4689

100 Professional Park Dr
Cumming, GA 30040
Phone (770) 889-4898

540 Dahlonega St
Ste 100
Cumming, GA 30040

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elba Montalvo-Torres Individual Corporate DirectorBoard Member May 18, 2010
Gary Riggs Individual Corporate DirectorBoard Treasurer Jun 21, 2016
Todd Shifflet Individual Contracted Managing EmployeeCeo Apr 13, 2015 100%
Corporate OfficerCeo Apr 13, 2015 100%
Jesann Hendrix Individual Corporate DirectorBoard President Oct 31, 2021
Karen Denise Cox Individual W-2 Managing Employee Nov 1, 2022
Georgia Highlands Medical Services, Inc. Organization, Cumming, GA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2022 100%
Gina Santos Individual Corporate DirectorBoard Member May 8, 2010

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1194987412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 307",
            "address_2": "GA HIGHLANDS MEDSVCS, PROFESSIONAL PARK FAMILY PRA",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300280307",
            "telephone_number": "770-887-1668",
            "fax_number": "770-781-9937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 DAHLONEGA ST",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402110",
            "telephone_number": "770-887-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA HIGHLANDS MEDICAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-27",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "SHIFLETT",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-887-1668",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GHMS Cumming Elementary Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.